European medical schools and tobacco.

Following a survey in 19 European countries of the habits, attitudes and knowledge of medical students regarding tobacco, World Health Organisation European Office and the International Union against Tuberculosis and Lung Disease jointly circulated to the Deans of all European medical schools a summary of the results, including figures for mortality for smoking-related diseases in their countries and a brief questionnaire concerning faculty action on the tobacco problem. The response rate was just over 50%, higher in Northern Europe (66%) than in Southern (35%) or Eastern (38%). Only 8% of faculties had a specific teaching module on tobacco. In most it was either systematically (35%) or unsystematically (55%) integrated in other teaching. Teaching hospitals, teaching areas and faculty meetings were said to be smokefree by over 90%; figures were lower for other areas. Seventy-seven per cent of Deans intended to discuss our approach with their teaching staff; 72% gave the name of a staff member with a particular tobacco interest.

[Attitudes of French cardiologists towards smoking]. / Les cardiologues français face au tabagisme.

The object of this study was to evaluate the attitudes and opinions of French cardiologists towards smoking. A postal enquiry was performed with the aid of the French Society of Cardiology and the French Federation of Cardiology in 1993 using a questionnaire developed by the World Health Organisation and the International Union against Tuberculosis and Respiratory Diseases (IUATRD). Seven hundred and thirty cardiologists replied (34% of the study population). The average age was 47 +/- 9 years; 84% were male. The prevalence of smoking was 27% (14% daily smokers and 13% occasional smokers); 47% were former smokers and 26% had never smoked. The proportion of physicians who had never smoked was higher in the younger age groups (29 to 45 years) than in the older age groups (33% versus 21% in the over 45). Forty-two per cent of daily smokers had tried seriously to stop smoking at least once but only 16% hoped to stop smoking in the following 5 years. Young cardiologists were more aware of the cardiovascular and respiratory diseases related to tobacco consumption. Only 64% of cardiologists (54% of daily smokers) systematically warned a smoker if the patient had no tobacco-related illness or did not ask about smoking systematically. Forty-seven per cent of those who replied stated that they were underinformed about the methods of helping patients to stop smoking. The authors conclude that fewer French cardiologists smoke than their general practitioner counterparts (14% of daily smokers versus 21%). They have a better understanding of the respiratory and cardiovascular risks of tobacco consumption but seem to be insufficiently prepared to help their patients to stop smoking. In addition, their personal behaviour with regards to smoking influences their attitude towards patients who smoke.

Attitudes and opinions of French cardiologists towards smoking.

To assess attitudes and opinions of French cardiologists towards tobacco, a postal survey was performed in 1993 of all members of the French Society of Cardiology using a questionnaire designed by the World Health Organisation (WHO) and the International Union against tuberculosis and lung diseases (IUATLD) for health professionals. 730 cardiologists responded to the mailing. The mean age of them was 47 + or - 9 years, 84% were males. The prevalence of smoking was 27% (14% daily smokers and 13% occasionally smokers). There were more never smokers in age group < 45 than in those aged 45 and more (33% vs 21%). Of daily smokers, 42% claimed to have made a serious attempt to stop smoking, but only 16% expected to have stopped within five years of the survey. French cardiologists aged 29-45 years had a better knowledge of tobacco related respiratory and cardiovascular diseases than those over 45 years old. Only 64% (54% of daily smokers) would counsel a patient to stop smoking if he did not have a smoking related illness and did not himself raise the question. 53% thought they had sufficient knowledge to advise their patients on stopping smoking. The results compared to those of the French general practitioners survey, showed a lower prevalence of daily smokers. French cardiologists especially those aged 29-45, have a better knowledge of the risk of cardiovascular diseases. But only 64% of them would advise any smoker patients. These results also demonstrated the influence of personal smoking on the attitude of cardiologists towards smoker patients.

Medical education on tobacco: implications of a worldwide survey. Tobacco and Health Committee of the International Union against Tuberculosis and Lung Disease (IUATLD).

This report considers the implications for medical education of a global survey of the knowledge, behaviour and attitudes of medical students regarding tobacco. This was conducted in 42 countries derived from all continents. A total of 9326 students (44% women) from 51 medical schools replied anonymously to a multiple choice questionnaire administered in the local language. Student smoking rates varied greatly between countries/regions: daily smoking in men from 2% (Australia) to 48% (one centre in the former USSR); in women from nil in some Asian medical schools to 22% in one European. Though there was some variation between countries and medical schools, there was widespread ignorance of the causal role of smoking in specific diseases; notably coronary artery disease, peripheral vascular disease, emphysema, bladder cancer and neonatal mortality. There were widespread defects in knowledge and motivation regarding counselling patients to quit smoking, with a common failure to appreciate a doctor's responsibilities in prevention. Very few students knew the value of tobacco taxation in reducing consumption. Following our survey we were asked to advise the World Health Organization on a summary of the desirable tobacco content of medical curricula, which has now been issued. The International Union against Tuberculosis and Lung Disease, in cooperation with the European Region of WHO, has circulated the Deans of all European medical schools with a summary of the deficiencies revealed by the European component of the survey, together with a questionnaire on proposed action. A similar initiative is being considered in cooperation with the Western Pacific Region of WHO.

[Smoking habits in France among general practitioners and the general male population over a twenty-five year period (1966-1991)]. / Vingt-cinq ans de tabagisme en France (1966-1991) chez les médecins praticiens et la population générale masculine.

Epidemiological surveys are presented regarding smoking habits among two populations: the general practitioners in France since 1966 to 1991 and the general population of adult men in the same period of time. We add some European and foreign surveys in the same groups of population. These data show a regular and rather slow reduction of percentage of smokers during the last 25 years. We can see, in general, the behaviour of the general practitioners are in advance comparing with the general population of ten to twenty years. If we compare the French data with the foreign one we can see that France is not in a very good situation regarding the decreasing tendency of smoking among the general practitioners and in the general population. This study justify the strengthening of the fight against smoking among adults and doctors. We remind that the very roots of the tabagism are in the youth: specific studies might take in account this core problem.

Smoking habits and attitudes of medical students towards smoking and antismoking campaigns in nine Asian countries. The Tobacco and Health Committee of the International Union Against Tuberculosis and Lung Diseases.

As part of a world survey of the habits, knowledge and attitudes of medical students regarding tobacco we report a study in 15 medical schools from nine Asian countries. Some 1646 first year and 1587 final year students were included, of whom 59% were male. The prevalence of daily smoking in males was 4% in first year and 11% in final year; of occasional smoking 18% and 24% respectively, both with considerable variations between countries. The rates were very low in women. Male exsmokers varied from 3% to 24% in different centres. Overall, 33% of smokers had made a serious attempt to quit; 44% expected to have succeeded within 5 years. Over 80% of non- or exsmokers, but only 60% of smokers, thought smoking was harmful to health. There was gross underestimation of tobacco's causal role in a number of important diseases, e.g. coronary artery disease, peripheral vascular disease, emphysema, bladder cancer and neonatal mortality. There were notable defects both in training and in motivation to counsel smoking patients. There was only partial knowledge of legislative and other measures to discourage smoking, e.g. only 44% of final year students (26% of smokers) thought increased taxation an important measure. In knowledge and attitudes there was little difference between the sexes, but in most aspects smokers had notably lower scores.

[Sequential administration of a reduced dose of almitrine to patients with chronic obstructive bronchopneumopathies. A controlled multicenter study]. / Administration séquentielle d'une posologie réduite d'almitrine à des malades BPCO. Etude multicentrique contrôlée.

Recent multi-centre studies have shown that high doses of Almitrine (100-200 mg per day), lead to a significant improvement in the hypoxaemia of patients presenting with chronic airflow obstruction, but that a high blood level (greater than 500 ng/ml) is often seen after 1 year, sometimes associated with signs of peripheral neuropathy. In order to maintain Almitrine blood levels in the range 200-300 ng/ml we have used an intermittent regime (with a "window" of 1 month every 3 months) and a dose limited to 100 mg per day. 102 hypoxic patients with chronic airflow obstruction, who were in a stable state were included. 65 patients were in the Almitrine group (A) and 37 patients in the placebo group (P). The treatment lasted for 1 year. In addition there was a 3 monthly follow up with arterial blood gases and spirometry, a clinical neurological examination and also electrophysiology, initially and after 6 and 12 months. 43% of patients in group A and 32% of patients in group P, left the study, most often due to poor cooperation, but sometimes as a result of side effects. After 12 months the PaO2 rose significantly in group A from 59.1 +/- 0.7 to 65.8 +/- 1.6 mmHg (p less than 0.001) whilst it was not changed in group P. The PaCO2 did not change in either group. On the other hand there was a significant fall in the subgroup of patients with hypercapnia in group A (p less than 0.001). The outcome of the neurological and electrophysiological assessments did not show any significant difference between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Actual usage of medical facilities by asthmatics in two French rural settings: a preliminary study.

Until recently the medical management of asthmatic patients with respect to their socio-cultural environment had only been superficially studied. Four hundred and fifty eight adult asthmatics were identified through a two-stage questionnaire in two rural districts of south west France. The study has mainly demonstrated: 1) the large number of subjects experiencing more than one attack per week (33% in Gironde, 40% in Lot et Garonne); 2) the large number of subjects feeling disabled in their occupational and day-to-day life (52% in Gironde, 54% in Lot et Garonne); 3) the absence of a relationship between the severity of the disease and the use of medical facilities in the community. Despite the frequency of the attacks and the perceived disability, 27% of the patients felt that their asthma did not require any treatment and up to 60% did not seek medical help even during an attack; 4) the role of population density, type of dwelling and social status in the management of asthma. We conclude that under-treatment is widespread in these two rural settings and is closely related with the association of at least two of these three characteristics: 1) living in a low population density area; 2) living in an isolated dwelling; and 3) being a farm owner.

The role of medical associations against smoking.

Smoking is a medical concern. Doctors were the first to recognize the health hazards of smoking. So far, the knowledge of doctors concerning smoking is not really good and their attitude against smoking is not adequate. To change the attitude of doctors, it is necessary to modify the curriculum, multiply publications, intervene through the media, and create medical associations. The role of medical associations is to assess knowledge and attitudes; to reply to a lack of knowledge; to assess how people react; to motivate smokers to quit smoking; and to participate in preventive measures in information and education. The members of associations should be models of nonsmokers. They could also be associated with health workers. The members of such associations should intervene to improve regulations and legislations against smoking.

[Passive smoking: from annoyance to disease, an unrecognized risk taken into account]. / Le tabagisme passif: de la gêne à la maladie, un risque méconnu à prendre en compte.

The I.S. is an uncontestable health hazard. Carboxy-hemoglobin and cotinine are present in biologic fluids of the non smoking people exposed to I.S. The health hazard is important among young children. The excess of lung cancer mortality among non smokers exposed to I.S. is today well known. Legislation and regulation might be completed and applied in public places. Specific measures might be decided and applied in the workplaces. In the family, parents might be educated to take in account the risk of I.S. for their children.

Smoking habits and attitudes of medical students towards smoking and antismoking campaigns in fourteen European countries.

From an ongoing global international survey we present the results for 14 European countries. The survey was carried out through a WHO-based questionnaire given to the students at the beginning of their first year and during the course of their final year. Daily smokers comprised 13.7% in first year and 21.5% in final year, with an overall variation between 3 and 33% according to country. There were already 16% of ex-smokers among first year students. More than 50% of smokers had made attempts to quit. 60% of daily smokers, and almost all others, thought that they would no longer be smoking in five years time. Knowledge of aetiology was moderate in first year. It later improved but there remained many lacunae in final year, e.g. less than 30% were aware that smoking was a cause of coronary artery disease. There was little knowledge of public health measures for smoking control. Attitudes were greatly influenced by smoking; ex-smokers were similar to non-smokers, with occasional smokers intermediate between these and daily smokers. Only 25% accepted a preventive and educative role in advising patients. As regards smoking, students were concerned with their personal health and with advising patients whom they knew to have smoking-related disease, but in general had little conception of smoking as a public health problem. The differences between countries indicate that both habits and attitudes are social and cultural problems. In most of the centres there seemed to be much room for improvement of medical education in this field.

[Delayed-action theophylline versus placebo on the ventilatory function of stable asthmatic patients. Study in relation to circadian rhythm]. / Essai d'une théophylline longue action contre placebo sur la fonction ventilatoire de l'asthmatique stable. Etude en fonction du rythme nycthéméral.

The aim of this study was to measure the results of a long-acting theophylline (Planphylline) on the flow rates of stable asthmatic patients while taking into account the spontaneous circadian variations of the ventilatory function. 27 patients were involved in this randomized, double-blind, cross-over trial; they received 10 mg/kg/day in two doses at 8.30 a.m. and 8.30 p.m or the placebo. The product was administered over two 4-day periods separated by a 3-day wash-out period. The theophylline concentration and bronchial flows (FEV1; MMEFR 25-75) were measured at 8 a.m., 10.30 a.m., noon, and 3 p.m. on days 1 and 4 of each period; 11 patients measured their hourly PEFR from 8 a.m to 10 p.m those same days. The results can be analysed for 19 patients, including the 11 who measured their PEFR. The first day of treatment (D1), the theophylline concentration rose regularly without going above 10 micrograms/ml. On the fourth day of treatment (D4), the mean maximum concentration was above 10 micrograms/ml and the 8 a.m rate was superior to 8 micrograms/ml for 14 patients out of 19. The bronchodilating effect of Planphylline is significant for all bronchial flow rates (FEV1 less than 0.01; MMEFR 25-75 less than 0.05; PEFR less than 0.01, n = 11). On D1, the FEV1 becomes normal. On D4, the MMEFR 25-75 is still only partially improved, in spite of the theophylline concentration obtained. Because of the spontaneous diurnal improvement of bronchial rates, only the 8 a.m, 10.30 a.m. and 3 p.m. FEV1 obtained with Planphylline are statistically different from those obtained with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Respiratory function and bronchial reactivity in mill workers.

Professional exposure to vegetable dusts affect the respiratory function of the exposed subjects. A previous survey conducted in an industrial flour-mill demonstrated a higher frequency of respiratory symptoms in workers compared to a control group. Ten subjects employed in a work site particularly exposed to dust were studied. Each subject answered a questionnaire and performed on Mondays and Fridays, at the beginning and end of his work shift, a flow volume curve and an isocapnic hyperventilation test. The aerobiology of the professional environment was also measured. We noted: 1) in the flow volume curves: a drop in the FEV1 during the Monday morning shift, a significant difference between the FEV1 (p less than 0.05) and the MMEFR 25-75 (p less than 0.05) measured at 6 am on Monday and Friday, and between the MMEFR 25-75 values obtained at 12 noon on Monday and Friday (p less than 0.05). 2) after isocapnic hyperventilation, a significant drop in the MMEFR 25-75 at 6 am on Monday (p less than 0.01) and in the FEV1 and MMEFR 25-75 at 12 noon on Mondays (p less than 0.05), a significant drop in the FEV1 at 1 pm on Monday (p less than 0.01).

[Multicenter study of the clinical efficacy and tolerance of roxithromicin compared to doxycycline in lower respiratory infections]. / Etude multicentrique de l'efficacité clinique et de la tolérance de la roxithromycine comparée à la doxycycline dans les infections respiratoires basses.

In a double-blind, randomised investigation in 305 in-patients, roxithromycin and doxycycline were compared in two groups of patients with low respiratory tract infections. Three hundred cases were analyzable for safety and 276 for clinical efficacy. Mean duration of treatment was 9 days in both groups. Clinical effectiveness was 83% (112/135) for roxithromycin (150 mg bd) and 84% (118/141) for doxycycline (200 mg once daily), the difference not being statistically significant. A 90% clinical response rate was obtained with roxithromycin in pneumoniae. Safety and tolerance were good and comparable in both groups.

[French medical students and tobacco]. / Les étudiants en médecine français et le tabac.

This is a pilot study by UICTMR on smoking habits in medical students carried out in five countries before a world study is undertaken. Smoking habits are already established for first year medical students and for fifth year medical students of both sexes. Cessation of smoking, however, is common in the young. One smoker in two hopes to stop. Knowledge of the dangers of smoking is reasonably good. However the study shows, above all, that students have not integrated into the medical field the education about and prevention of smoking, and they appear limited in their openness to the broader conceptions of Public Health.